Until now, 2009 swine flu pandemic has had a mortality rate of 0.85%, as against a 0.6% seen in a usual influenza infection, and about 10% in case of 2002-03 SARS flu. The fatality numbers (percentage) may be higher in India, possibly because we are in early stages. Also, in absence of any clearly defined protocol for treatment of “flu like” symptoms, and a huge queuing in front of limited facilities currently conducting H1N1 tests, only those patients who are severely affected are getting themselves tested, hence higher fatality is expected in such sample. Key question is that if it is not dangerous, then why all nations are in a state of panic? The very obvious reason is that though flu are mild in themselves, they affect large number of people, thus cause significant drainage on healthcare resources. Another reason can be the history of H1N1 (the culprit virus), especially what it did in 1918. At that time, there was a deadly pandemic outbreak referred to as “Spanish Flu”. It ran from 1918 to 1920 and in that 2-year span, infected an estimated of 30% of people across globe, KILLING 3 to 6% of world’s population!! In India alone, an estimated 17 million people or 5% of our population that time, DIED. This is the deadliest disease outbreak known to mankind. H1N1 has thus had past history of mutating into virulent strands. Coupled with the fact that it is highly infectious, as flu viruses usually are, it can potentially be very scary. So although there is nothing that should arouse abnormal fear as of now, there could be a deadlier “second wave” in the making. Usually, odds are stacked against “deadlier” variants spreading, simply because people with severe symptoms are more likely to stay confined, and those with milder form, more likely to roam about, however, the 1918 episode was different from usual flu pandemics in two ways: • It had a “second wave” of widespread infections from a highly virulent strand, against the odds. • The second wave killed people thorough immunity hyperactivity i.e. body’s defence mechanism became over engaged to an extent that it destroyed what it was supposed to protect. This resulted in YOUNG ADULTS whose immunities were relatively better, becoming primary victims, as opposed to old persons and infants, as is the case with most flu. On our personal front, we need to take care that we do not end up spreading the disease to others in the community. We human beings are programmed to act strongly on “not getting the disease from others” objective, as opposed to acting with “even if I have been infected, let me ensure that others do not get it from me” mind set. Alas if that were so, there may not be any epidemics at all. Anyways, we cannot change the way we are wired to think, but we can consciously try to do as much in ensuring that even if we have got the virus, it must stay with us only. Flu virus transmit from one person to another almost always in saliva/secretion droplets from infected person so things like coughing and sneezing carefully, and possibly behind a mask/handkerchief can contain an epidemic. (As an aside, you must have seen the green masks that are so ubiquitous now. The main motivation of people wearing them is that they think that by doing so, they will not get infected. It is a different matter that it is not a common knowledge that these green masks may not be able to prevent virus inhalation as effectively as needed. Per an article written by a doctor, in order to make those masks virus proof, one needs to wear four of them, with the outermost being soaked in beta dyne solution, and preferably wet. Would so many people “buy” masks at the prices at which these are being sold today, if they were to realize that the main purpose they serve is to have others not catch your infection, and not vice versa ?) Next in line would be to continue taking usual caution to avoid contacting infections - wash our hands with soap frequently, avoid rubbing our eyes and nose, and taking simple steps to enhance our immunity e.g. getting proper sleep, having a good well balanced diet, and doing reasonable amount of aerobic exercises. (Just make a mental note of the fact that 1918 h1n1 impacted those with better immunities, more!! ) What can the Government do? Imagine a scenario when 30% of the population indeed gets infected, as our governments “official” estimate stands. At that scale, no amount health facilities would suffice. What needs to be done RIGHT NOW is to define a protocol for treatment of patients who show flu like symptoms, and this protocol must take into consideration our supply lines as well. The next thing should be to stop the wave of panic that has led people to throng in scores to the few hospitals that offer swine flu tests as of today. The right thing to do would be to increase the awareness of the fact that swine flu is not any deadlier than an ordinary flu, and there is no need for peple to “react” any differently when they realize that they could be suffering from swine flu, than they would if they came to know that they could have “a” flu. Most people, around 99.2% of those who suffer from a swine flu today, will come out of it through simple symptomatic treatment (i.e. paracetamol). There is far too much of panic that is not justified at all. Surreal as it may sound, but if you are anticipating the deadlier “second wave”, it might even be worth getting infected by current milder form and acquire immunity now itself!! Thirdly, the Government should step in as aggressively as it can, in procurement and distribution of testing kit and drugs that a person tested +ve would subsequently need. Increase the capacity for handling the number of patients – that means medicine, equipment and other supplies, and create effective channels for their distribution. More can be done to strengthen the role of “at-home” administration and management of this disease. For example, today we have the ability to reach out to most children in their localities during “polio drops” campaigns. Can the same ability not be used to collect nose swabs from all people with certain symptoms? These can then be conveyed for testing, and on the basis of the results, infected people could be provided with required drugs. Of course this will require scaling up in terms of number of test kits, protection gear for the workers who would go to the communities, equipment to transport swabs to centralized laboratory (including encoding/marking them for identification) and so on. However, in this process, people who could be potentially ill will remain in confinement of their homes so that the disease does not spread. Finally, the government needs to pool in the private healthcare players, or at least, stop its office bearers from making irresponsible statements that would leave them too threatened to do anything. Let’s accept that on the scale we are staring at, every person getting infected of swine flu will NOT get Tamiflu. Every person getting infected may not even NEED Tamiflu to get well. What is certainly needed is good hospital care for people with severe conditions. In a nation where a large chunk of healthcare facilities are in private hands, nothing can be more catastrophic than a situation when these players feel so “threatened” that they shy away from providing basic hospital care to suspected victims. So those holding good offices, instead of making statements to “look good” in front of the media, should instead channelize their energies (and even their “threats”) in getting the private players play their role. Post Script I am not a medical practitioner and this note is based on my observations, media/news report, articles I read on the Internet, and, finally, my experience from “viral fever” episode of my son, developed on 10th Aug 09. by Maneesh Mehra
